Alcohol Through the Lifespan: Current Trends in Consumption, Treatment, and Criminal Behavior

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Alcohol Through the Lifespan Current Trends in
Consumption, Treatment, and Criminal Behavior
Mitchell Karno, Ph.D.
Presented at the 61st Semi-annual meeting of the
Association for Criminal Justice Research
(California) McClellan, California March 18, 2005
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Costs of Alcohol Abuse to the Nation - 1990
Total 98.6 Billion

• Core Medical Expenditures 10.5 Billion
• Specialty organizations (33)
• Short-stay hospitals (44)
• Nursing homes (10)
• Support Other (13)
• Indirect 70.3 Billion
• Morbidity (52)
• Mortality (48)

• Other Alcohol-related Costs 15.8 Billion
• Crime (36)
• Victims of crime (3)
• Incarceration (30)
• Motor vehicle crashes (24)
• Fire destruction (4)
• Social welfare administration (1)
• Fetal Alcohol Syndrome 2.1 Billion

Rice, 1993 NIAAA, Alcohol Health, 1997
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Total per capita ethanol consumption, United
States, 1997
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Total Per Capita Consumption of Ethanol by State,
United States, 1997
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Total Per Capita Consumption of Ethanol among
Current Drinkers by State, United States, 1997
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Concentration of U.S. Alcohol Consumption
Greenfield TK Rogers JD. J Stud Alcohol 6078
(1999)
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Hazardous U.S. Alcohol Consumption
Rogers Greenfield, 1999
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Heavy Drinking by Age, Sex, and Race
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Alcohol Consumption in U.S.2002 2003

• About 65 of persons aged 12 or older reported
  any alcohol use in past year.
• About 23 of persons aged 12 or older reported
  binge drinking in past 30 days.
• About 7 of persons aged 12 or older reported
  heavy drinking in past 30 days.

(SAMHSA, 2004)
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Heaviest Use Is Among Young Adults

• Rates of binge and heavy drinking peak at age 21
  (about 48 and 19, respectively).
• Young adults in college were somewhat more likely
  than their non-college counterparts to engage in
  binge or heavy drinking.

(SAMHSA, 2004)
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With Age Comes Moderation?

• Among young adults 18-25, rates of binge and
  heavy drinking are 42 and 15.
• Among persons 45-49, rates of binge and heavy
  drinking are 23 and 7.
• Among persons 65 and older, rates of binge and
  heavy drinking are 7 and 2.

(SAMHSA, 2004)
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How does California compare?2001-2002

• 62 of Californians reported alcohol use in past
  year.
• 45 of Californians aged 18-25 reported binge
  drinking at least once in past year.
• 16 of Californians aged 18-25 reported at least
  weekly binge drinking over past year.

(NIAAA, 2004)
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Definition of Alcohol Abuse

• A person's maladaptive alcohol use causes
  clinically important distress or impairment, as
  shown in a single 12-month period by one or more
  of the following
• failure to carry out major obligations at work,
  home, or school because of repeated alcohol use,
• repeated use of alcohol even when it is
  physically dangerous to do so,
• repeated experience of legal problems, or
• continued use of alcohol despite knowing that it
  has caused or worsened social or interpersonal
  problems.

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Definition of Alcohol Dependence

• A person's maladaptive pattern of alcohol use
  leads to clinically important distress or
  impairment, as shown in a single 12-month period
  by three or more of the following
• tolerance
• withdrawal
• amount or duration of use often greater than
  intended
• repeatedly trying without success to control or
  reduce alcohol use
• spending much time using alcohol, recovering from
  its effects, or trying to obtain it
• reducing or abandoning important work, social, or
  leisure activities because of alcohol use or
• continuing to use alcohol, despite knowing that
  it has probably caused ongoing physical or
  psychological problems.

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Alcohol Abuse and Dependence by Age, Race, Sex
NLAES, 1991
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Alcohol Abuse DependenceAggregate-2001/2002

• Met criteria for diagnosis in past year
• Abuse 4.3
• Dependence 3.5
• Met criteria for diagnosis prior to past year
• Abuse 16.2
• Dependence 10.3

(NIAAA, 2004)
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Two Worlds of AlcoholismHelp-Seeking in 1991

• Only 10 of the U.S. adult population currently
  abusing or dependent on alcohol had received any
  treatment in the 12 months prior to interview.
• Only 28 of individuals with a past diagnosis of
  alcohol dependence reported ever having any kind
  of alcohol treatment.
• 75 of the people who recovered from a previous
  alcohol disorder did so without having received
  any treatment, often termed natural recovery.

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Help-Seeking 2001/2002

• Pattern of low help-seeking continues.
• Among persons with recent alcohol abuse or
  dependence, only 7 reported seeking assistance
  in past year.
• Only 25.5 of individuals with a past diagnosis
  of alcohol dependence reported ever seeking any
  kind of help.
• 75 of persons with prior abuse or dependence no
  longer meet criteria.

(NIAAA, 2004)
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Understanding Help-Seeking Pattern

• Demographics
• Clinical Issues
• Access

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Client Characteristics

• Demographics GENDER
• Gender Disparities In Help-Seeking
• Women may be less likely to enter alcoholism
  specialty treatment.
• Women more likely to seek care in mental health
  or primary car/general medical settings.

Source Weisner et al., 1992 Grant, 1996
Kaskutas et al., 1997 Booth et al.,
2000. NLAESNational Longitudinal Alcohol
Epidemiologic Survey.
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Client Characteristics

• CLINICAL
• Alcohol use severity
• Psychiatric comorbidity
• Previous treatment
• Alcohol consequences
• symptoms DSM-IV alcohol use disorder (NLAES)
• Diagnosis of alcohol disorder (NAS, NHIS)
• Social consequences of drinking (NAS 1984 F/U,
  RAS)

Source Grant, 1997 Kaskutas et al, 1997 Booth
et al., 2000, Hasin Grant, 1995.
NLAESNational Longitudinal Alcohol
Epidemiologic Survey, RASRural Alcohol Study,
NASNational Alcohol Survey, NHISNational Health
Interview Survey
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Client Characteristics

• ACCESS
• Availability availability in the geographic area
• -tremendous variation across U.S.
• Accessibility travel time, driver's license, car
• -longer travel times reduce outpatient
  use
• Affordability income, health plan, cost of care
• -NLAES employment
• - HIP better insurance coverage
• Acceptability stigma
• Accommodation convenience

Source Penchansky Thomas, 1981 Fortney et
al., 1995 Manning et al., 1996 Grant, 1997
Booth et al., 2000 Fortney Booth, in press.
RASRural Alcohol Study NLAESNational
Longitudinal Alcohol Epidemiologic Survey
HIPRAND Health Insurance Experiment
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Rural/Urban Differences in Access
Variable
Rural
Urban
Source Booth et al., 2000.
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Independent Predictors of Help-Seeking
Variable
OR
Booth et al., 2000. ORodds ratio, listed only
when p lt 0.05.
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Locations Providers of CareHelping With
Drinking
The Rural Alcohol Study 40 service users
Source Booth et al., 2000.
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The influence of alcohol on morbidity and
mortality Alcohol-Attributable Fractions (AAF)

• AAF Age
• Causes of death directly attributable to alcohol
  1.0 gt15
• Diseases indirectly attributable to
  alcoholCancer of the esophagus 0.75 gt 35Acute
  pancreatitis 0.42 gt 35
• Injuries and adverse effects indirectly
  attributable to alcoholMotor vehicle traffic and
  non-traffic deaths 0.42 gt 0Suicide and
  self-inflicted injury 0.28 gt 15Homicide and
  injury purposefully
• inflicted by others 0.46 gt 15

Source Stinson, F.S., and DeBakey, S.F.,
Alcohol-related mortality in the United States,
1979-1988, Brit. J. Addict. 87777-783, 1992.
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Alcohol Criminal Behavior
(Health and Human Services NHSDA, 1997)
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Alcohol Workplace Violence

• 1/3rd of victims of workplace violence between
  1993 1999 believed the perpetrator was under
  the influence of alcohol or drugs at the time of
  the crime (Bureau of Justice Statistics, 2001).

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Alcohol Domestic Violence

• Perpetrator problem drinking has been associated
  with an 8-fold increase in intimate partner
  violence. (Walton-Moss et al., 2002)

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Alcohol Youth Violence

• Youth aged 12 to 17 who reported violent
  behaviors at school or at work reported high
  rates of past year alcohol use compared with
  youths who did not report violent behavior.
  (National Clearinghouse for Alcohol and Drug
  Information, 2002).
• Alcohol has been implicated in 46 to 75 percent
  of the reported acquaintance rapes among
  15-to-24-year-olds. (National Center on Addiction
  Substance Abuse, 1999).

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Summary

• Alcohol consumption nationwide has remained
  relatively stable over the past several years.
• Patterns of consumption in California are similar
  to that seen nationwide.
• Binge and Heavy use peak among young adults, and
  then steadily decline with age.
• Relatively few persons seek help for alcohol use
  problems.
• Alcohol use is associated with increases in a
  wide variety of criminal activity.